Requirements, in terms of root canal treatment, of undergraduates in the European Union: an audit of teaching practice

How Is Endodontics Taught in Italy? A Survey of Italian Dental Schools

The aim of our study was to investigate how endodontics is taught in Italian universities. An online survey was conducted from August to December 2021. A comparison between courses led by full or associate professors (Group 1) versus courses led by other figures, such as researchers or temporary lecturers (Group 2), was made. A total of 28 out of 36 schools participated (78%). In most schools, endodontics is taught in the fifth year to 15-29 students. All schools planned pre-clinical endodontic training, and in 25/28 schools (89.3%), clinical endodontic training was also provided. The course programs varied among schools, and significantly more hours were allocated to teaching nonsurgical root canal treatment in Group 1 schools than in Group 2 schools. The average numbers of hours of preclinical and clinical training were 34.3 ± 23.6 and 84.1 ± 76.7, respectively. All schools used rotary NiTi files in their clinical training, and the vertical condensation of hot gutta-percha was the most frequently taught obturation technique. As expected, the scenario of endodontic education in Italian universities was variable and needs harmonization. Courses led by full or associate professors seem to be better structured.

A Critical Evaluation of the Undergraduate Endodontic Teaching in Dental Colleges of Saudi Arabia

BACKGROUND

The purpose of the research was to evaluate the content and delivery of the undergraduate endodontic curriculum.

METHODS

A needs assessment survey was distributed among the Deans of all the dental colleges in Saudi Arabia.

RESULTS

The response rate was 72%. All the colleges include foundational and advanced topics in their curriculum. Didactic lectures, clinical cases, self-directed learning assignments and projects, and videos are the most common teaching methods, whereas virtual learning and reading list are the least popular methods. The average staff-to-student ratio for preclinical and clinical training is 1:6 and 1:7, respectively. Eighty-six percent of colleges utilize dedicated endodontic clinics supervised by specialized endodontists. Eighty percent of colleges use simple cases for canal preparation and obturation. Most colleges do not use magnification and ultrasonic instruments. Saline and sodium hypochlorite are preferred irrigation solutions, whereas calcium hydroxide is the preferred inter-visit medicament. Many use MTA as an advanced material, calcium hydroxide as an inter-visit medicament, and provisional restoration after RCT.

CONCLUSION

The content and delivery of the endodontic undergraduate curriculum are primarily uniform. The use of specialist endodontists dedicated endodontic clinics, rotary instruments, and advanced materials have emerged as curricular strengths. However, diversification of teaching strategies, use of magnification instruments, and an increase in the minimum number of endodontically treated teeth are leading areas demanding curricular improvement.

Progress and challenges in the harmonisation of European undergraduate dental education: A systematic literature review with narrative synthesis

INTRODUCTION

Harmonising education to support workforce mobility has been a policy objective for the European Union. However, alignment across varied national contexts presents challenges in dental education.

METHODS

A systematic literature review with narrative synthesis. Searches of the electronic databases Embase [Ovid]; MEDLINE [Ovid]; Scopus; CINAHL; AMED and PsycINFO were conducted for relevant material published between 2000 and 2019 on undergraduate curricula, quality standards and learning outcomes in dentistry.

RESULTS

Seventy-six papers met the inclusion criteria. Fifty-three papers were commentaries or editorials, twenty-one were research studies, and two were literature reviews on specific dental subfields. Eighteen of the research studies reported surveys. The literature contains extensive proposals for undergraduate curricula or learning outcomes, either broadly or for subfields of dentistry. Included papers demonstrated the importance of EU policy and educator-led initiatives as drivers for harmonisation. There is limited evidence on the extent to which proposed pan-European curricula or learning outcomes have been implemented. The nature and extent of dental students' clinical experience with patients is an area of variance across European Union member states. Arrangements for the quality assurance of dental education differ between countries.

DISCUSSION

Harmonisation of European dental education has engaged educators, as seen in the publication of proposed curricula and learning outcomes. However, differences remain in key areas such as clinical experience with patients, which has serious implications if graduate dentists migrate to countries where different expectations exist. Mutual recognition of professional qualifications between countries relies on education which meets certain standards, but institutional autonomy makes drawing national comparisons problematic.

Use of contemporary technologies and new materials in undergraduate Endodontics teaching

Background

This study aims to analyze the use of contemporary technologies and materials in undergraduate endodontic teaching in Spain.

Material and Methods

The survey was sent to the undergraduate endodontic programme leads in the 23 Spanish dental schools. The survey asked about the use of magnification, ultrasonic devices, electronic apex locator, rotary instruments, root-filling techniques, and bioceramic cements in the teaching of endodontics.

Results

The response rate was 91%, and the final number of schools included in the study was twenty. Only two schools (10%) used magnification (loupes or operative microscope). Five schools (25%) used ultrasonic devices to prepare the access cavity, and four (20%) to activate the irrigation solution. In 14 dental schools (70%) no type of ultrasonic instrument was used. Electronic apex locators in working length determination was used in 19 schools (95%). All schools used rotary instrumentation in the teaching of endodontics, and 45% of schools used reciprocating instruments. Five schools (25%) used warm vertical compaction technique, four (20%) single cone gutta-percha technique, and four (20%) thermoplastic injection techniques. No school used carrier-based gutta-percha. Bioceramic cements were used in 19 of the schools (95%).

Conclusions

Spanish dental schools have incorporated some of the new endodontic technologies and materials, including the electronic apex locator, rotary instruments, and the new bioceramic cements; however, the modern root filling techniques, magnification, and ultrasonic instruments are not yet used in most dental schools.

Key words:Bioceramic materials, dental schools, endodontic curriculum, magnification, online survey, rotary instrumentation, ultrasonic devices.

An investigation into security, self-confidence and gender differences related to undergraduate education in Endodontics

AIM

To analyse responses from dental practitioners (DPs) on how secure they felt as a newly graduated dentist, level of confidence or self-efficacy when performing root canal treatment (RCT), and if undergraduate (UG) education in Endodontics adequately met their needs in a dental practice.

METHODOLOGY

An electronic questionnaire was sent to 459 dentists who graduated from the University of Bergen, Bergen, Norway, between 2008 and 2018. The survey consisted of questions with closed-end options and Likert scale (1-5). An open-ended free text option was always provided.

RESULTS

A total of 314 (68.4%) DPs answered the questionnaire. Of these, 87 (27.8%) were men and 224 (71.3%) were women. Three respondents did not disclose their gender. As a newly graduated dentist, 37.3% of the respondents felt secure when performing RCT, 30.7% felt indifferent, and 32.0% felt insecure. The majority (72.4%) of respondents were either confident or very confident when performing RCT, 21.3% were indifferent, and 6.3% had little or no confidence. A majority of DPs (84.4%) self-evaluated the quality of their root fillings as good or very good, and 15.2% were indifferent. Only one DP selected 'not good' and none selected 'bad'. There were significant gender differences where male DPs felt more secure than female DPs when performing RCT (P < 0.001). A significantly larger number of men were very confident compared to women (P < 0.001). A logistic regression analysis using confidence as a dependent variable to predict self-efficacy revealed that DPs who felt secure when performing RCT as a newly graduated dentist had about 8 times more self-efficacy (odds ratio = 8.49) than those who were insecure or indifferent. Respondents who rated their quality of root fillings as good or very good had forty times more self-efficacy (odds ratio = 40.06) when performing RCT. UG education in endodontics was considered inadequate by 71.3% of the respondents where a significantly larger number of DPs (70%) wanted more clinical training (P < 0.05). About half the DPs (47.7%) stated that there was a need for lifelong learning with majority preferring hands-on courses and continuing dental education organized by dental associations.

CONCLUSIONS

The results of this study suggest that there is a need to promote self-efficacy during UG education in Endodontics. Hands-on training is the preferred form of lifelong learning for DPs.

Shared Decision Making in Endodontics

Engaging patients in shared decision making (SDM) is a professional requirement since the Montgomery ruling in 2015. Endodontic treatments present a specific challenge to achieving SDM, both for the clinician and the patient. The treatments are often perceived as more challenging to complete by the clinician, and the assessment of risk and likely outcome requires a deep understanding of the (limited) evidence base. For the patient, decisions can be required at a time of acute symptoms and prolonged treatments. There are health literacy demands in comparison to some less complex dental treatments. Treatment decisions may be based more on inherent biases and prior experiences than objective probabilities. This article discusses options and supports effective shared decision making in endodontic treatment.

Evaluation of undergraduate Endodontic teaching in dental schools within Spain

AIM

To evaluate the current situation of undergraduate endodontic teaching in Spanish dental schools.

METHODOLOGY

An online version, translated into Spanish, of a survey conducted in the UK (Int Endod J 52, 2019, 1077) was sent via email to the undergraduate endodontic programme leads in all 23 Spanish dental schools.

RESULTS

The response rate was 96%. In 95% of dental schools, endodontics is taught in the fourth year. Students treat simple root canal treatment cases in 100% of schools and only in 40% treat moderate cases. In 65% of schools, students are supervised by full-time professors who are specialists in Endodontics, significantly more frequently in private dental schools (P = 0.002). Spanish dental schools use both rotary and reciprocating instrumentation systems during endodontic training, with consistency on methods of working length determination, use of silicate-based endodontic cements, irrigating solutions, inter-visit medicaments and canal filling techniques. No type of magnification is used in 90% of dental schools, and only 25% use ultrasonic instruments. Private dental schools have a significantly better staff: student ratio during clinical practice (P = 0.041), spend significantly more hours in clinical training (P = 0.04) and have significantly greater number of clinical areas specifically dedicated to Endodontics (P = 0.010).

CONCLUSIONS

Undergraduate endodontic teaching in Spanish dental schools follows the key recommendations of the ESE Undergraduate Curriculum Guidelines (Int Endod J 46, 2013, 1105), being, in most respects, comparable to that carried out in the UK (Int Endod J 52, 2019, 1077). The use of magnification and ultrasonic instruments needs to be increased. Private schools reported better results than public schools in some of the variables that were analysed.

Are the evaluation criteria used in preclinical endodontic training courses relevant? A preliminary study

This study aimed to evaluate the relevance of a conventional evaluation protocol (CEP) for preclinical endodontic training. Seven dental students performed root canal treatments on an extracted human molar which was then evaluated by CEP (clinical and radiographic observations, including preparing the access cavities, preparing and filling the root canal, and detecting iatrogenic errors). A reference evaluation protocol (REP) based on micro-computed tomographic images analysis was used as a control. The evaluation scores obtained by CEP and REP were compared using a non-parametric Wilcoxon's test. CEP was relevant for access cavity, irrigation, working length and ledge detection training but was no more effective than the REP for evaluating the apical diameter and taper of the root canals, the quality of the fillings, and the presence of perforations and fractured instruments using retro-alveolar radiographs. The conventional evaluation criteria used in preclinical endodontics should be used with care to detect 'unsafe' students.

Self-efficacy of undergraduate dental students in Endodontics within Aarhus and Amsterdam

AIM

To understand whether the self-efficacy of undergraduates is associated with the extent of the endodontic education they received.

METHODOLOGY

Data were obtained from three undergraduate endodontic programmes in two universities: Aarhus University (AU), Denmark and the Academic Centre for Dentistry Amsterdam (ACTA), the Netherlands. Just before their graduations in 2016 or 2017, students completed a questionnaire that contained the Endodontic General Self-Efficacy Scale and questions on how they valued the education they received in Endodontics. The information on the number and type of root canal treatments participants had performed on patients was collected from dental clinic management systems. Data were ana-lysed using non-parametric tests and multiple regression analyses.

RESULTS

The median number of treated root canals on patients per student was 5 in the standard programme at ACTA, 10 in AU, and 14.5 in the extended programme at ACTA. Students' self-efficacy increased with the number of treated root canals; however, retreatments and root canal treatments in molars were negatively associated with self-efficacy. All students wanted more experience in performing root canal treatment on patients.

CONCLUSIONS

The endodontic self-efficacy of students from the standard programmes of the two participating universities was comparable. Students' self-efficacy was influenced mostly by their clinical experience when performing root canal treatment. It seems that the more root canal treatments students perform on patients, the greater their self-efficacy is at graduation. However, treating difficult cases (molars and retreatments) might reduce their self-efficacy.

Perception of Undergraduate Students at the Faculty of Medicine in Hradec Králové Regarding Their Endodontic Education and Suggested Improvements

AIM

The aim of this study was to assess the perception of undergraduate dentistry students at Charles University, Faculty of Medicine in Hradec Králové, the Czech Republic regarding their endodontic education within the context of the Undergraduate Curriculum Guidelines for Endodontology by the European Society of Endodontology (ESE). The secondary aim was to compare this perception among students in the Czech and English groups.

METHODOLOGY

A questionnaire survey was conducted among fifth year students at the very end of their studies.

RESULTS

The students returned 60 filled questionnaires, making the response rate of 75.9%. More than two thirds of the respondents declared that they were competent at or had knowledge of most of the major competencies defined by the ESE. Eighty seven percent of respondents felt competent to perform a root canal treatment on anterior teeth; 86.7% on premolars; and 48.3% on molars. Nearly all respondents (98.3%) recommended more opportunities to practice on patients.

CONCLUSIONS

The overall perception of the students was that their endodontic education was sufficient and largely conformed to the guidelines. Insufficient exposure to endodontic practice on patients was identified as a deficiency. There were no significant differences in perceptions between the two study groups.

The confidence of undergraduate dental students in Saudi Arabia in performing endodontic treatment

Objective:

This study examined the endodontic experience, perceptions of endodontic practice, and self-rated confidence of dental students enrolled in Taibah University, Saudi Arabia.

Materials and Methods:

A questionnaire was distributed to 41 undergraduate dental students registered in endodontic courses in the 2015 academic year. The questionnaire evaluated their confidence performing nonsurgical root canal treatment. The level of confidence was classified using a 5-point scale as “very confident,” “confident,” “neutral,” “not very confident,” or “not at all confident.” The data were analyzed using SPSS version 20.0 (SPSS, Chicago, IL, USA).

Results:

The participation rate was 93%. The maxillary incisor was the most common first tooth treated. The students were relatively confident, but their confidence levels were lower regarding endodontic radiology, evaluation of root canal obturation, and determining the correct recall period for the patient.

Conclusion:

The confidence of undergraduates in endodontics must be enhanced to increase their clinical competence when performing root canal treatment.

Method of teaching undergraduate students to perform root canal treatment: It's influence on the quality of root fillings

INTRODUCTION

This study aimed to assess whether the method of teaching endodontology influenced the quality of root fillings made by undergraduate students.

MATERIALS AND METHODS

The method of teaching endodontology at our institution was revised. Changes concerned: the programme (ie method of clinical training and summative assessment), and the supervision whilst performing root canal treatment on patients. An intermediate cohort (N=91) comprised partly students attending the former programme (involving patients) and partly students attending the revised programme (without patients). After succeeding in the summative assessment, the quality of the first root filling made by the student in a patient under supervision of either a general dental practitioner or an endodontist was evaluated according to pre-determined criteria. Data were analysed using Cohen's Kappa, Chi-square, Fisher's exact, Mann-Whitney and Kruskal-Wallis tests.

RESULTS

Sixty-two per cent (47 of 76) of root fillings made by students who attended the revised programme were of good quality, in comparison with 47% (seven of 15) of those made by students who attended the former programme (P=.274). Less complex treatments had better quality root fillings if students were supervised by endodontists (88% (14 of 16) good quality) than supervised by general dental practitioners (59% (22 of 37) good quality) (P=.045). Complex treatments did not differ in quality of root fillings for the supervision types (P=.825).

CONCLUSION

The quality of root fillings made by students who attended the revised programme seems at least as high as that of those who attended the former programme. Higher quality root fillings might be obtained under supervision of endodontists than under supervision of general dental practitioners.

Undergraduate Confidence When Undertaking Root Canal Treatment and Their Perception of the Quality of Their Endodontic Education

The General Dental Council expects graduating dentists to be competent at treating pulpal disease. Previous studies have found dental undergraduates to have low levels of confidence with respect to endodontic treatments. The aim of this study was to investigate the confidence of undergraduate dental students at the University of Bristol when performing root canal treatment, and to investigate their perception of the quality of their endodontic education. An anonymous questionnaire, based upon one used in a 2015 study at Cardiff University, was distributed to all (n = 204) undergraduate students in Years 3–5 at the University of Bristol. The results were analysed using the Statistical Package for the Social Sciences software (SPSS). There was a 59% (n = 120) response rate and a significant (p < 0.01) difference in confidence levels for root canal treatments (RCTs) completed between these students. All (100%) Year-5 students felt confident in completing anterior RCTs, and 91% felt confident in completing posterior RCTs. The majority (93%) of Year-4 students felt confident in completing anterior RCTs, and 77% felt confident in completing posterior RCTs. Over one-half (56%) of Year-3 students felt confident in anterior RCTs and 17% in posterior RCTs. With respect to the individual stages of RCT (access cavity, cleaning and shaping of root canal system, and obturation/filling), results showed that there was a significant difference (p < 0.01) in confidence levels between year groups. Many students thought the amount of time spent on endodontic teaching and the quality of teaching to be satisfactory. Improvements suggested for future endodontic teaching included higher numbers of staff supervision and additional endodontic practice on extracted teeth before seeing patients. There was a strong association between students’ clinical experience and their levels of confidence when completing RCT. Increasing the amount of clinical experience of RCTs could enhance students’ confidence further.

The confidence of undergraduate dental students when performing root canal treatment and their perception of the quality of endodontic education

AIM

This article aims to gain understanding into the perception of undergraduate dental students in terms of their confidence and competence at performing root canal treatment and their perception of the quality of endodontic education.

METHODS

An online questionnaire was distributed to all 3rd, 4th and 5th year dental students at Cardiff University via their academic e-mail addresses. The questionnaire utilised both scaled response and open questions to gain an insight into undergraduate opinion.

RESULTS

Out of a possible 208 students, 98 responses were obtained (response rate = 47%). Perception of competence and confidence were significantly greater amongst the more senior year groups (P < 0.01). However, 49% (n = 38) of participants did not feel competent performing root canal treatment on anterior, single-rooted teeth, whilst 74% (n = 70) did not feel competent performing root canal treatment on posterior, multirooted teeth. Free comments from participants indicated that this was due to a lack of clinical experience. Approximately, 80% of participants ranked education in endodontics at Cardiff University as ≤5 on a Likert scale (1 = inadequate to 10 = good), indicating that improvement was required. Improvements that were suggested by the students included the provision of further information within lectures, a broader range of lecturers, an increased number of shorter, more organised practical sessions, additional training equipment, greater supervision and online reference guides to root canal treatment.

CONCLUSION

Enhancing undergraduate education in endodontics is necessary to increase students' perception of their confidence and competence when performing root canal treatment.

Satisfaction of undergraduate students at University of Jordan after root canal treatment of posterior teeth using rotary or hand preparation

The aim of this study was to report the satisfaction of fifth year undergraduate students on the clinical use of rotary endodontic preparation compared with stainless steel standard technique and to evaluate the impact of rotary nickel-titanium instruments on undergraduate teaching. This study was carried out by the fifth year undergraduate students attending peer review sessions as a part of their training program using a questionnaire to assess their satisfaction with these two techniques. The overall results indicated a statistically significant satisfaction of the undergraduate students with the use of the nickel-titanium system (P < 0.001) compared to stainless steel standard technique. Under the conditions of this study, the results showed a positive acceptance and consensus among novice dental students regarding the use of ProTaper rotary files and the need for undergraduate teaching of rotary nickel-titanium systems in Jordan.

Quality of Root Canals Performed by the Inaugural Class of Dental Students at Libyan International Medical University

Objective. The purpose of this study was to radiographically evaluate technical quality of root canal fillings performed by dental undergraduates at Libyan International Medical University in Libya. Methods. Root canal cases were treated at university dental clinic from the fall of 2012 to the fall of 2013 by the fourth and fifth year dental students. Students used step-back preparation and cold lateral compaction in the treatment. Radiographs were reviewed over a two-year period from initial procedure to final restoration. Radiographs were evaluated for adequacy or inadequacy by length, density, and taper. Length inadequacy was classified as short or overextended. Overall quality was considered "adequate" based on all three variables. Chi-square tested differences between teeth groupings and adequacy classification. Significant p value results were adjusted by Bonferroni correction. Results. Adequate length of root canal fillings were observed in roughly half of all samples (48.6%). Density was adequate in 75.8% of the samples. Taper was observed as adequate in 68.8%. Higher quality was evident in anterior teeth (plus premolars) versus molars (65.6% versus 43.3%, resp.; p < 0.04). Conclusion. Overall quality of endodontic treatment performed by undergraduate dental students was adequate in 53.9% of the cases. Significant opportunity exists to improve the quality of root canals provided by dental students.